I have uneven eyelids after ptosis surgery. Can anything be done?
A common goal in eyelid surgery is to seek symmetry between both eyes, particularly in the cases of ptosis where the initially presenting problems may include asymmetry along with issues like functionality and aesthetics. Ptosis is commonly understood as a “droopy” eye, and the presence of ptosis may differ between two eyes.
If you have already had eyelid surgery but find that you still have uneven eyelids even after ptosis surgery, you do have options. First it is important to understand the nature of your concern, which can only be accomplished with the help of an experienced oculoplastic surgeon. The goal with any eyelid surgery is improvement, and unfortunately the nature of ptosis often causes asymmetry, which is not always completely resolved but can be dramatically improved. At times a first surgery can yield great improvements, and a second surgery my be desired to make good results even better.
Unfortunately there are times when you may be dissatisfied with a surgery for reasons related disappointment that the surgery did not accomplish what was promised or what you understood was promised. This often occurs when the procedure is performed by a surgeon who does not specialize in offering eyelid ptosis surgery. Due to the nature of ptosis, a disappointing result can also occur in the hands of a specialist, even one who did everything right. Dr. Steinsapir specializes in both eyelid surgery as well as repairing dissatisfactory eyelid surgery, as it relates to the natural appearance and aesthetic of the whole face, and is widely respected for his ability to improve disappointing results.
Before traveling to see Dr. Steinsapir for a second opinion, understand you’re your original surgeon has recommended regarding you surgical result. Sometimes something as simple as healing more can make a big difference in the outcome. Occasionally things can transpire after surgery to take the shine off your relationship with your original surgeon. It can be very difficult if you do not feel you are being hear, or feel that you lack confidence in your surgeon. Under these circumstances it is appropriate to seek a second opinion.
Dr. Steinsapir helps many individuals who are concerned about a previous procedure by listening to their concerns, providing a detailed physical examination, and advising on a plan to move forward. Sometimes a fear amounts to just “nerves” or the anxiety of someone who is not allowing themselves enough time to heal, and other times there are concerns that warrant further care. In either case, it’s important that you have access to a doctor with whom you feel comfortable, and one who closely monitors your recovery. In many cases Dr. Steinsapir has helped to repair the relationship and restore communication with the original surgeon. In other cases when you need more specialized care, Dr. Steinsapir has provided exemplary corrective surgery for many, and will be happy to help you better understand your options.
Call us today to schedule a risk-free consultation in a friendly environment where you can feel comfortable discussing your situation, and where you can receive honest answers from a caring, world-renowned oculofacial surgeon. There is no reason to remain with your doubts when there is help available now.
About Dr. Steinsapir
Dr. Steinsapir is a board certified eye surgeon and fellowship-trained in oculoplastic surgery and cosmetic surgery in Los Angeles where he specializes in balanced facial cosmetic surgery for natural results, with an emphasis on minimally invasive techniques, fast recovery time, and leadership in medical technology. Dr. Steinsapir has a private practice and also serves as an Associate Clinical Professor of Ophthalmology at the Jules Stein Eye Institute, at the David Geffen School of Medicine at UCLA. Contact us today to learn how Dr. Steinsapir’s experience and training make him an expert in cosmetic surgery, which can be a vital part of your evidence-based treatment plan.
Services described may be “off-label” and lack FDA approval. This article is informational and does not constitute an advertisement for off-label treatment. No services should be provided without a good faith examination by a licensed physician or surgeon and an informed consent with a discussion of risks, benefits, alternatives, and the likelihood of treatment success. Only you and your treating physician or surgeon can determine if a treatment is right for you.
Transconjunctival versus Transcutaneous Lower Eyelid Surgery
Transconjunctival and transcutaneous lower eyelid surgeries are each a type of lower blepharoplasty, a plastic eyelid surgery that can address a range of issues such as excess fat or “puffiness” around the lower eyelid, loose and wrinkled skin. For great results, your blepharoplasty must be carefully planned by your attending surgeon, who will consider the subtle details of your facial anatomy when determining which type of blepharoplasty is right for you, and details such as whether to remove any fat and where, how tight the eyelid skin should be, and how to achieve natural results for overall facial balance.
Lower eyelid blepharoplasty can be approached either through the skin, transcutaneously, or from behind the eyelid, transconjunctivally. There can be very specific reasons for choosing one approach over another. More commonly, surgeons use a particular approach, not due to inherent advatages of the approach but rather that was they way they were trained. For the most part, tranconjunctival surgery is performed by oculoplastic surgoens who by training are comfortable working near the eye. General plastic surgeons and others lack the specialized training in oculoplastic surgery. They prefer an approach to the eyelid that does not require they to work so close to the eye surface. This is unfortunate because the skin incision usually is made through the underlying muscle. This can damage the function of the underlying muscle, the orbicularis ocli muscle. After surgery, this muscle weakness account for the alteration of the lower eyelid contour that is routine associated with transcutaneous lower eyelid surgery.
Here is an overview of some important features of each surgery type:
Transconjunctival Blepharoplasty
• Incision made behind the lower eyelid
• Minimizes the risk of altering the contour of the eyelid margin after surgery
• Arcus marglinalis release can be performed through the same incision, wherein the eyelid fat is preserved and rotated into the hollow under eyes
Transcutaneous Blepharoplasty
• Incision made just below the lower eyelid lashes
• Can possibly damage the function of the orbicularis oculi muscle and affect the lower eyelid contour
• Permits the removal of excess skin
For some, removal of the lower eyelid fullness from behind the eyelid and removal of excess skin from the front is indicated, via a skin pinch technique or an infracillary incision just below the eyelashes that preserves the underlying muscle. Ultimately, the only way to know what treatment method is right for you is to consult with an experienced oculoplastic surgeon who will meet with you, discuss your concerns and treatment goals, perform a physical examination, and work with you to design an approach that addresses your specific anatomical features and overall facial balance. These are highly complex and specialized procedures that require a skilled and experienced hand, and can bring you many benefits both functional and aesthetic. To schedule a consultation with Dr. Steinsapir, a leading cosmetic eyelid surgeon who practices in Beverly Hills and at UCLA, please call us today.
About Dr. Steinsapir
Dr. Steinsapir is a board certified eye surgeon and fellowship-trained in oculoplastic surgery and cosmetic surgery in Los Angeles where he specializes in balanced facial cosmetic surgery for natural results, with an emphasis on minimally invasive techniques, fast recovery time, and leadership in medical technology. Dr. Steinsapir has a private practice and also serves as an Associate Clinical Professor of Ophthalmology at the Jules Stein Eye Institute, at the David Geffen School of Medicine at UCLA. Contact us today to learn how Dr. Steinsapir’s experience and training make him an expert in cosmetic surgery, which can be a vital part of your evidence-based treatment plan.
Services described may be “off-label” and lack FDA approval. This article is informational and does not constitute an advertisement for off-label treatment. No services should be provided without a good faith examination by a licensed physician or surgeon and an informed consent with a discussion of risks, benefits, alternatives, and the likelihood of treatment success. Only you and your treating physician or surgeon can determine if a treatment is right for you.
What is supratarsal fixation and how does it differ from anchor blepharoplasty?
Supratarsal fixation is really an antiquated method that invites the surgeon to form a crease that is simply too high for virtually every patient. The natural eyelid crease is caused by connective tissue fibers that firmly connect the eyelid platform skin to the underlying levator aponeurosis tendon. This tendon connects the upper eyelid to the levator palpebrae superioris muscle in the orbit. This muscle is responsible for opening the eyes. The connective tissue fibers from the levator aponeurosis to the skin form the upper eyelid crease and support the eyelid platform skin and upper eyelid lashes. If these fibers stretch out, which happens as we age, or are not present, which is seen in some Asian eyelids, the skin of the eyelid platform will be loose and the eye lashes will hang down (eye lash ptosis).
Anchor blepharoplasty is a blepharoplasty technique where the levator aponeurosis is exposed at the time of surgery, and stitches are placed from the cut upper eyelid platform skin and muscle to the exposed levator aponeurosis. By doing this in a very precise fashion, the upper eyelid lashes are supported and perky and the eyelid platform skin is snugged over the eyelid platform much like someone might pull a bed sheet taut. This technique requires both absolute precision to be done well and a very detailed knowledge of eyelid anatomy. In Dr. Steinsapir’s experience less than 2% of all eyelid surgeons are able to perform an anchor blepharoplasty.
So-called supratarsal fixation should be another name for an anchor blepharoplasty. However, it is seldom actually practiced this way. Surgeons often interpret this procedure to mean “above the top of the tarsus.” Effectively they do away with the surgical dissection needed to identify the levator aponeurosis. Instead they interpret supratarsal to mean sewing the cut edge of the eyelid platform skin somewhere above the top of the tarsus. Effectively this often means sewing the skin to something much more superficial such as the orbital septum. This is not the same thing. The levator aponeurosis is a mobile structure. When you open the eyes, the levator aponeurosis slides up and back. Anything attached to the levator will also slide up and back. When the eyelid platform skin and underlying muscle are accurately attached to the levator aponeurosis, the eyelid platform skin stays well snugged and the eye lashes well supported whether the eyelids are open or closed. In contrast, if the skin is “supratarsally” fixed, the skin is snug (or too tight i.e. the eyelids are short of skin) when the eyes are closed and loose when the eyes are open.
Another issue with so-called supratarsal fixation is that it is often associated with a surgical look. This is because the upper eyelid crease is made too high. The top of the tarsus is 10 mm from the actually eyelid margin. To fixate above the tarsus, the crease is being made north of 10 mm. In addition, with healing the crease normally creeps even higher by one or two millimeters. It is not unusually to see crease height of 12 or even 14 mm. This height is at the expense of the upper eyelid fold which is often surgically wiped-out. This makes the upper eyelid look too hollow-think Barbra Walters.
In contrast, a properly done anchor blepharoplasty can be done at almost any height above the eyelid margin with preservation of the upper eyelid fold.
About Dr. Steinsapir
Dr. Steinsapir is a board certified eye surgeon and fellowship-trained in oculoplastic surgery and cosmetic surgery in Los Angeles where he specializes in balanced facial cosmetic surgery for natural results, with an emphasis on minimally invasive techniques, fast recovery time, and leadership in medical technology. Dr. Steinsapir has a private practice and also serves as an Associate Clinical Professor of Ophthalmology at the Jules Stein Eye Institute, at the David Geffen School of Medicine at UCLA. Contact us today to learn how Dr. Steinsapir’s experience and training make him an expert in cosmetic surgery, which can be a vital part of your evidence-based treatment plan.
Services described may be “off-label” and lack FDA approval. This article is informational and does not constitute an advertisement for off-label treatment. No services should be provided without a good faith examination by a licensed physician or surgeon and an informed consent with a discussion of risks, benefits, alternatives, and the likelihood of treatment success. Only you and your treating physician or surgeon can determine if a treatment is right for you.
Asian eyelid surgery is not about Westernizing the eyes!
We’ve said this before, but it’s worth repeating: Asian eyelid surgery is not about westernizing the eyes. In fact, there is no one standard approach to Asian eyelid surgeries such as blepharoplasty and double fold surgery, because there are no two people with identical sets of eyes. When we refer to “Asian eyelid surgery,” what we mean is that certain features more common in the shape and contours of Asian eyelids must be uniquely considered and comprehensively understood by an experienced oculofacial surgeon for optimal results.
All kinds of individuals seek cosmetic eyelid surgery in the form of blepharoplasty, lidlift, reconstructive surgery, double fold surgery, and other procedures designed to enhance the appearance and functionality of the human eyelid. Eyelid surgery is about improving your natural eyelid structure in a way that compliments your natural appearance. The end result is a bright appearance that seems fitting for you and does not look “surgical” or “westernized” at all.
Your specialized oculofacial surgeon’s attention to Asian eyelid surgery in fact means the opposite of westernization: your treatment should not be a cookie-cutter “one size fits all” approach, but rather one that takes your natural eyelid shape into account and seeks to enhance it rather than transform it. While Asian eyelid surgery does not aim to “westernize” one’s features, it calls for exacting and meticulous attention to detail, as well as experience with proven results. A common error that Dr. Steinsapir is often consulted for to provide a correction is double folds that are made too high. In almost all cases this is caused by a surgeon who fundamentally does not understand the surgery. The surgeon may be inexperienced or simply lack the necessary grasp of what is required to make a natural double fold. Sometimes the inexperienced surgeon is simply following the wrong textbook and intentionally makes the crease incision too high as a result. Asian eyelid creases need to be place low in order to create an natural appearing double fold.
We invite you to look through Dr. Steinsapir’s unretouched before and after photos of various Asian eyelid surgeries. You can judge for yourself, but we believe you’ll find the results to all be very natural and fitting for the individual. The key to Dr. Steinsapir’s success is years of experience in eyelid surgery that includes Asian eyelid surgery as a specialization, with multi-fellowship training, prestigious education, an artistic eye, and a prioritization of individually designed treatment to enhance each person’s unique features. Call us today to schedule a consultation with Dr. Steinsapir and achieve natural results that enhance your personal attributes.
About Dr. Steinsapir
Dr. Steinsapir is a board certified eye surgeon and fellowship-trained in oculoplastic surgery and cosmetic surgery in Beverly Hills where he specializes in balanced facial cosmetic surgery for natural results, with an emphasis on minimally invasive techniques, fast recovery time, and leadership in medical technology. Dr. Steinsapir has a private practice and also serves as an Associate Clinical Professor of Ophthalmology at the Jules Stein Eye Institute, at the David Geffen School of Medicine at UCLA. Contact us today to learn how Dr. Steinsapir’s experience and training make him an expert in cosmetic surgery, which can be a vital part of your evidence-based treatment plan.
Services described may be “off-label” and lack FDA approval. This article is informational and does not constitute an advertisement for off-label treatment. No services should be provided without a good faith examination by a licensed physician or surgeon and an informed consent with a discussion of risks, benefits, alternatives, and the likelihood of treatment success. Only you and your treating physician or surgeon can determine if a treatment is right for you.
I have had a heavy upper eyelid since childhood. What are my options?
There is often confusion regarding what part of the eyelid is heavy. Eyelid surgeons draw an important distinction between a full upper eyelid fold (which is actually part of the eyebrow just below the eyebrow hair) and a heavy or ptotic eyelid margin. Ptosis means fallen and it is a general term than is used to describe a number of anatomic issues. How we address a ptotic upper eyelid margin and how we deal with a heavy eyebrow are very different. Upper eyelid ptosis where of margin of the upper eyelid rests low on the eye itself, is often present from childhood onward. The condition can pose both aesthetic and functional problems. Depending on the nature of your case, you may be dissatisfied with a “droopy” appearance of the eyelid, you may have concerns about asymmetry noted by other people, or you may have visual impairment and diminished peripheral vision. Heavy eyelids may be described as “bedroom eyes,” or sleepy eyes. Because the heavy eyelid convey a lack of attention, the presence of upper eyelid ptosis can be undesirable in both social and work situations. In contrast, an eye that is open correctly makes you look alert, interested, and engaged and is socially desirable in both work and social situations.
Ptosis usually does not go away on its own, particularly if this is a problem you’ve had since childhood. Ptosis can also develop after childhood. Considering how the upper eyelid tendon in held in the eyelid, it is actually quite amazing that more people do not have this condition. After a few million blinks of the eyelids, it is common to see some degree of upper eyelid ptosis. If you have a bothersome heavy upper eyelid and are beginning to consider your treatment options, it is important to research upper eyelid ptosis and clearly understand your choices. Ultimately there is no substitute for consulting with a qualified oculoplastic surgeon because every eyelid is different.
Correcting eyelid ptosis requires upper eyelid surgery. The challenge is determining the best approach that is right for your needs. This is not a place for having work done by a non-specialist lacking training, skills, and experience. Having ptosis correctly diagnosed increases the likelihood that surgery will correctly address your issues. Having things done the right way the first time is so much better than needing to undo the wrong surgery. Ptosis surgery can often be done in conjunction with other cosmetic eyelid procedures. The surgery will elevate the eyelid to an appropriate, natural level. It can also address eyelid asymmetry. Having the heavy eyelids corrected can make a huge difference in your confidence level, the business world, and personal interactions.
The first step is to consult with a cosmetic surgeon who specializes in eyelid surgery, including concerns related to ptosis, heavy eyelids, and asymmetry. At your consultation, your physician should give you a close and thorough examination, discuss your options and probable outcomes, and the likelihood of a surgery’s success and factors that can complicate surgery. The doctor will also make a formal diagnosis at this time, which will identify the ptosis and any compounding issues. For example, some individuals also have a heavy brow or dark under-eye circles, which may exaggerate the problem. Your surgeon should specialize in understanding on how each part of the face functions and relates to the other parts, and also advocate for nonaggressive surgery for natural-looking results. He or she can then design an individual treatment plan for you that leaves you with an overall balanced look.
The first step really begins by seeing the right surgeon. The key to being happy with your results is to never take a shortcut in choosing a surgeon. Your surgeon must be a true specialist in ptosis correction, and similarly will not take any shortcuts or use a “one size fits all” approach to your care. It is important to understand the value of seeing an aesthetically oriented, fellowship trained oculoplastic surgeon. The plastic surgeon who did your girlfriend’s breast surgery or nose is all too often the wrong choice because they lack specialized training in ophthalmology and in oculofacial surgery. To be a fellowship trained oculoplastic surgeon means the surgeon is board certified in ophthalmology and has spent a minimum of two additional years training in eyelid plastic surgery. Dr. Steinsapir is board certified in ophthalmology and completed three years of training in oculoplastic surgery fellowships and two additional years of cosmetic surgery fellowship training. This advanced training early in his career has helped propel him to the forefront of his field.
A highly qualified cosmetic eyelid surgeon is the best option. Surgeons do vary, so it is recommended that you review unretouched before-and-after photos of eyelid surgery; spend time with the surgeon beforehand discussing your options, plan, and follow-up care; and understand your doctor’s treatment philosophy, which should advocate for a nonaggressive, individualized approach.
Dr. Steinsapir is highly qualified to treat eyelid ptosis, asymmetry, and related concerns. With particular attention to individualized care, multiple fellowships in eyelid surgery, and a specialization in ptosis correction, he can help you with your goal to realize a bright and natural appearance. Dr. Steinsapir is internationally regarded as a top eyelid surgeon. Call us today to schedule a consultation and finally take that next step in addressing your longstanding concern. You shouldn’t have to wait any longer.
About Dr. Steinsapir
Dr. Steinsapir is a board certified eye surgeon and fellowship-trained in oculoplastic surgery and cosmetic surgery in Los Angeles where he specializes in balanced facial cosmetic surgery for natural results, with an emphasis on minimally invasive techniques, fast recovery time, and leadership in medical technology. Dr. Steinsapir has a private practice and also serves as an Associate Clinical Professor of Ophthalmology at the Jules Stein Eye Institute, at the David Geffen School of Medicine at UCLA. Contact us today to learn how Dr. Steinsapir’s experience and training make him an expert in cosmetic surgery, which can be a vital part of your evidence-based treatment plan.
Services described may be “off-label” and lack FDA approval. This article is informational and does not constitute an advertisement for off-label treatment. No services should be provided without a good faith examination by a licensed physician or surgeon and an informed consent with a discussion of risks, benefits, alternatives, and the likelihood of treatment success. Only you and your treating physician or surgeon can determine if a treatment is right for you.
I had eyelid surgery 8 days ago and I am certain that my surgeon made a mistake. What should I do?
Blepharoplasty is an invasive surgical procedure and by definition, requires time to heal. Eye surgery causes trauma to the tissue surrounding your eyes and it’s difficult to determine how your eyes will look, even after a week or more. In the grand scheme of things, eight days is not enough time to determine the majority of mistakes. Even if your doctor did cause a complication, it’s possible it will clear up during the healing process. However, there are some rare complications to be mindful of and consult your physician immediately if you are experiencing the symptoms.
Immediate post-operative issues
Dr. Steinsapir uses the term “immediate” to describe post-operative issues and complications that last from moments after surgery to up to six months, whereas long-term complications are issues that persist for more than six months. He uses the six month time frame because a number of concerns related to upper eyelid crease height, difficulty closing the eye, mild lower eyelid retraction or alterations in eyelid shape often resolve spontaneously within this time period.
Dry eye
One of the most common problems after surgery is dry eye. Swelling and temporary lid dysfunction can exacerbate pre-op dry eye issues. When the eyelids are swollen after surgery, they do not move the tears around very well and this can cause drying and irritation. This type of swelling can typically affect eye comfort for ten days or more when there is normal tear production. When the eyes are dry, eye comfort may be affected by post-operative eyelid swelling for several weeks before resolving.
If, however, the surgery damages the nerve fibers that supply the muscle that closes the eye (orbicularis oculi muscle), the blink mechanism may be permanently affected causing long-term eye surface drying and dry eye symptoms like irritation, sensation of burning, grittiness, and redness. Fortunately, many of these closure issues get better over time. You can treat these dry-eye symptoms with artificial tears and bland ophthalmic ointment. Additionally, Dr. Steinsapir may choose to supplement this by plugging the tear drainage system, and taping the eyes closed.
Bruising
Bruising is natural and anticipated following surgery; it is a normal part of recovery. On rare occasions, a much more significant bruise can occur. If this happens deep behind the eye, the bruise can cause blindness. This type of bleeding is called a retro-orbital hemorrhage. While these cases are very rare, it is this very significant risk that prompts the eyelid surgeon to advise potential patients to avoid medications and herbal products that can thin the blood and predispose to bruises in the first place.
Bleeding that causes bruising after surgery can occur from straining, coughing or other activities that disrupt the clots that normally form from the surgical wounds. For this reason, it is essential for your potential eyelid surgeon to know if you are taking a blood thinner such as aspirin, coumadin, or Plavix. In these circumstances, Dr. Steinsapir will advise against elective or optional eyelid surgery.
Superficial bruising may not threaten vision but these bruises can affect the outcome of surgery. Severe bruises cause swelling that can stretch a healing eyelid. In the upper eyelid, this can produce heaviness in the upper eyelid that might need to be corrected surgically if there is no resolution after 6 months. When the resulting eyelid malposition does not satisfactorily resolve by 6 months after surgery, revisional surgery may be necessary to address the issue.
Stitches
Occasionally, stitches closing the surgical incision come apart before the skin edges are healed together. This is called a wound dehiscence. This most commonly occurs in the upper eyelid where an incision is made to remove excess skin. The raw edges of skin separate and the wound gapes open. This can be unsightly and it is tempting to sew the raw edges back together. This may be the right thing to do, however, there may be a low-grade infection causing the wound separation in which case the best course of action is to simply observe the area, and keep it moist with extra antibiotic ointment. The most surprising thing about wound dehiscence is how well it heals on its own. It has been Dr. Steinsapir’s experience that given time to fully heal, the body pulls the skin edges back together so well that no further intervention is needed.
Swelling
Chemosis is a specific type of tissue swelling. The white of the eye is a specialized tissue called the conjunctiva. Just like the eyelids can swell following surgery, the conjunctiva can also swell. It looks like jelly along the edge of the eyelid. Mild chemosis is self-limited; it will resolve on its own. More severe chemosis is very rare and is almost never seen with standard blepharoplasty. In this circumstance, the swollen conjunctival tissues balloon to the point where they are not covered by the closed eyelids. When this happens, the conjunctiva is subject to drying that causes more swelling―becoming a cycle. The best treatment is aggressive lubrication with an ophthalmic ointment and when necessary, occlusion with plastic wrap to prevent drying. Surgical treatments are available for the rare instances when these measures are insufficient.
About Dr. Steinsapir
Dr. Steinsapir is a board certified eye surgeon and fellowship-trained in oculoplastic surgery and cosmetic surgery in Los Angeles where he specializes in balanced facial cosmetic surgery for natural results, with an emphasis on minimally invasive techniques, fast recovery time, and leadership in medical technology. Dr. Steinsapir has a private practice and also serves as an Associate Clinical Professor of Ophthalmology at the Jules Stein Eye Institute, at the David Geffen School of Medicine at UCLA. Contact us today to learn how Dr. Steinsapir’s experience and training make him an expert in cosmetic surgery, which can be a vital part of your evidence-based treatment plan.
Services described may be “off-label” and lack FDA approval. This article is informational and does not constitute an advertisement for off-label treatment. No services should be provided without a good faith examination by a licensed physician and an informed consent with a discussion of risks, benefits, alternatives, and the likelihood of treatment success. Only you and your treating physician or surgeon can determine if a treatment is right for you.
My surgeon performed eyelid surgery 6 weeks ago and now my eyes don’t close at night. What should I do?
Eyelid surgery is a delicate operation that has as many rewards, but it is still surgery and requires adequate healing time. As you begin to heal, you may notice problems with dry eyes, or your lids not closing properly. Immediately after surgery and for about ten days following, swelling may cause discomfort and concern about the new position of your lids. However, as your body heals, your lids may resume a more natural position. There is a small risk that the nerve fibers that supply the muscle that closes the eye (orbicularis oculi muscle), may be temporarily or permanently weakened causing long-term eye surface drying and dry-eye symptoms. Six weeks following surgery is too early to become alarmed, but Dr. Steinsapir strongly recommends visiting your original surgeon for a complete assessment of your condition to determine your treatment options. If your surgeon is not a fellowship trained oculoplastic surgeon, you may need to see one or a cornea specialist.
Why won’t my eyes close?
Surgery can produce long-term damage to the function of the eyelids causing dry eye symptoms. If your surgeon removes too much upper eyelid skin and underlying muscle, your eyes may not close completely, causing dry spots to develop on the cornea. Depending of the design of the blepharoplasty, the nerves that supply the muscle that helps to close the eye can be damaged weakening the blink reflex. This means that during a blink there may not be sufficient speed or force to cause the upper and lower eyelids to meet during the blink. Since the eyelids move tears on the eye surface around, the net result is surface drying.
What are my treatment options?
The first line approach to treating these issues is to increase the frequency of artificial eye drops and, when indicated, ophthalmic ointment at bedtime. If necessary, your tear drains in your eyelids can be closed temporarily with plugs to see if symptoms improve. If these measures fail, there are some additional mechanical measures available. Depending on the corneal status early surgical reconstruction may be necessary.
The extent of the solution depends on the severity of the symptoms and the degree of drying seen on the surface of the cornea. Although a range of options are available, the key objective is to make the eyelids meet and to create sufficient force of eyelid closure to help spread the tears over the corneal surface.
Is this a long-term issue?
Common post-operative issues can be thought of in two broad categories: immediate and long term. Immediate issues are post-operative issues and complications that present anytime from moments after surgery up to six months. Long-term complications are issues that continue to persist beyond six months. The six-month time frame is useful because a number of concerns related to difficulty closing the eye and mild lower eyelid retraction often resolve spontaneously in this time frame. In contrast, it is Dr. Steinsapir’s experience that when these types of problems are present six months after surgery and continue to be a concern, then they often need to be addressed with a corrective surgery.
I chose an experienced surgeon, what happened?
No matter how technically superb the surgeon, surgery can tip a marginally compensated dry eye to discomfort. Unpredictable individual factors may also contribute to a particular situation. Dr. Steinsapir is acutely aware of the importance of eye comfort after surgery and what steps are needed to make the eye as comfortable as possible. Unfortunately, specialists lacking the training in Ophthalmology can underestimate the impact of these easily addressed issues. For this reason, Dr. Steinsapir closely follows his patients after surgery. Your post-operative follow-up schedule is based on how you are actually doing rather than on a scheduled based on how everyone one else has done in the past.
About Dr. Steinsapir
Dr. Steinsapir is a board certified eye surgeon and fellowship-trained in oculoplastic surgery and cosmetic surgery in Los Angeles where he specializes in balanced facial cosmetic surgery for natural results, with an emphasis on minimally invasive techniques, fast recovery time, and leadership in medical technology. Dr. Steinsapir has a private practice and also serves as an Associate Clinical Professor of Ophthalmology at the Jules Stein Eye Institute, at the David Geffen School of Medicine at UCLA. Contact us today to learn how Dr. Steinsapir’s experience and training make him an expert in cosmetic surgery, which can be a vital part of your evidence-based treatment plan.
Services described may be “off-label” and lack FDA approval. This article is informational and does not constitute an advertisement for off-label treatment. No services should be provided without a good faith examination by a licensed physician and an informed consent with a discussion of risks, benefits, alternatives, and the likelihood of treatment success. Only you and your treating physician or surgeon can determine if a treatment is right for you.
